title: Chronic mania revisited: factors associated with treatment non-response during prospective follow-up of a large European cohort (EMBLEM).
abstract: OBJECTIVE
  To describe the course and outcome of patients with prospectively defined chronic mania and to identify predictors of treatment non-response.
  
  
  METHODS
  EMBLEM is a 2-year prospective, observational study of bipolar disorder treatment outcomes conducted in 14 European countries. Patients with a manic/mixed episode were assessed and prospectively followed for 1 year. Clinical scales (Clinical Global Impressions-Bipolar Disorder (CGI-BP) overall, mania, and depression; Young Mania Rating Scale (YMRS); and five-item Hamilton Depression Rating Scale (HAM-D-5)) and medication taken were systemically recorded. Treatment adherence and outcome measures were also captured. Chronic mania (non-response) was defined as not achieving more than one point improvement on CGI-BP mania scale during up to 12-month follow-up. The analysis was conducted with 3373 patients who had at least two CGI-BP mania ratings available.
  
  
  RESULTS
  A total of 15% of patients fulfilled criteria for chronic mania. Compared to those who responded to treatment, chronic mania was associated with lower severity of mania symptoms at baseline (OR = 0.44, 95% CI 0.37-0.52), shorter duration of current episode before treatment start (OR = 0.71, 95% CI 0.52-0.96), more delusions/hallucinations at baseline (OR = 1.12, 95% CI 1.03-1.22), less socially active (OR = 0.52, 95% CI 0.39-0.70) and greater occupational impairment (OR = 1.54, 95% CI 1.01-2.35) by multivariate statistical analysis.
  
  
  CONCLUSIONS
  Rather than severity or duration of manic symptoms, factors associated with chronicity in mania are the presence of psychotic symptoms and issues related to social and occupational functioning.
authors.affiliation: Bipolar Disorders Program, Hospital Clinic, University of Barcelona IDIBAPS, CIBER-SAM, Barcelona, Spain.
authors.forename: Willemijn G
authors.initials: WG
authors.lastname: Van Riel
authors.forename: Eduard
authors.initials: E
authors.lastname: Vieta
authors.forename: Anabel
authors.initials: A
authors.lastname: Martinez-Aran
authors.forename: Josep M
authors.initials: JM
authors.lastname: Haro
authors.forename: Jordan
authors.initials: J
authors.lastname: Bertsch
authors.forename: Catherine
authors.initials: C
authors.lastname: Reed
authors.forename: Jim
authors.initials: J
authors.lastname: Van Os
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology*; D002908:Chronic Disease; D015331:Cohort Studies; D017831:Diagnosis, Dual (Psychiatry); D004351:Drug Resistance; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011618:Psychotic Disorders / Q000453:epidemiology; D012917:Social Adjustment; D012919:Social Behavior; D019966:Substance-Related Disorders / Q000453:epidemiology